VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer
187,133MODERNA
33,878JANSSEN
2,321PFIZER\BIONTECH
1,091GLAXOSMITHKLINE BIOLOGICALS
983UNKNOWN MANUFACTURER
363MERCK & CO. INC.
229SEQIRUS, INC.
45DYNAVAX TECHNOLOGIES CORPORATION
41NOVARTIS VACCINES AND DIAGNOSTICS
29SANOFI PASTEUR
18EMERGENT BIOSOLUTIONS
8PAXVAX
7TEVA PHARMACEUTICALS
4PFIZER\WYETH
3BERNA BIOTECH, LTD.
2SMITHKLINE BEECHAM
2INTERCELL AG
2PROTEIN SCIENCES CORPORATION
1CSL LIMITED

Incidents per State

State Total
77,548
AK1,869
AL5,581
AR3,688
AS47
AZ14,288
CA61,984
CO11,665
CT8,149
DC1,663
DE1,807
FL37,749
FM5
GA15,058
GU120
HI2,453
IA4,625
ID2,692
IL20,334
IN24,007
KS4,615
KY7,696
LA4,887
MA14,654
MD12,514
ME3,129
MH11
MI18,739
MN12,528
MO9,710
MP29
MS2,790
MT2,375
NC16,368
ND1,356
NE2,880
NH3,100
NJ17,634
NM3,916
NV4,239
NY34,355
OH19,081
OK6,195
OR8,636
PA23,083
PR2,370
QM2
RI2,088
SC6,411
SD1,212
TN9,131
TX35,174
UT4,273
VA14,937
VI64
VT1,676
WA14,909
WI11,259
WV2,388
WY861
XB5
XL1
XV2

ID: 1299866
Sex: F
Age: 41
State: IL

Vax Date: 04/19/2021
Onset Date: 04/21/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Macrobid

Symptom List: Dysphagia, Epiglottitis

Symptoms: Tinnitus/ vertigo

Other Meds: Cyclobenzaprine 10mg, Diclofenac 50mg, Vitamin D,

Current Illness: None

ID: 1299867
Sex: F
Age: 49
State: NV

Vax Date: 02/09/2021
Onset Date: 02/11/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Neomycin, cilantro, pineapples, mango, papaya

Symptom List: Anxiety, Dyspnoea

Symptoms: After my vaccine and two days later I started to experience migraine headaches which I never suffered from before. I went to Quick care facility to seek treatment. To this day, I still have the migraine headaches and I can not function well and carry out my daily activities.

Other Meds: None reported

Current Illness: None reported

ID: 1299868
Sex: F
Age: 63
State: CA

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Chest discomfort, Dysphagia, Pain in extremity, Visual impairment

Symptoms: I received the vaccination at 9:45 am 5/6. At approximately 4 pm, I started getting chills, aches, and a headache. However, around 6 pm my hands started shaking violently. When I tried to pick up a Tylenol out of my son's palm, I couldn't. My hand was violently shaking 3-5 inches either way. I fell asleep shortly thereafter, and when I awoke several hours later, the shaking had stopped and I just had "normal" chills. Through the night, I had nausea and dry heaves. 24 hours after the vaccine most side effects have subsided. However, I am concerned that it affected my nervous system as I still have intermittent pain on the back of my right hand.

Other Meds: none

Current Illness: none

ID: 1299869
Sex: F
Age: 62
State: MA

Vax Date: 04/30/2021
Onset Date: 05/01/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: latex, Lisinopril

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Blood clot. PT had blood clot removed at hospital.

Other Meds: N/A

Current Illness:

ID: 1299870
Sex: F
Age: 40
State: NY

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Erythromycin

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Ague Fever, muscle ache, headache, chills which lasted for about 30 hours. Fever went down after taking ibuprofen. Currently (48 hours after vaccination) still tired, similar to recovering from a have fever and flu.

Other Meds: Vitamin C, D, B, Zinc, Fish oil

Current Illness: no

ID: 1299871
Sex: M
Age: 41
State: OH

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chills, Confusional state, Eye inflammation, Headache, Laboratory test

Symptoms: patient experienced sharp pain and problems breathing when going up stairs or standing . none while sitting down.

Other Meds:

Current Illness:

ID: 1299872
Sex: M
Age: 58
State: MN

Vax Date: 03/19/2021
Onset Date: 03/20/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Ragweed

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Extreme Fatigue , Blurry Vison, Inability to Focus/Concentrate - Brain Fog

Other Meds: Paxil Lisinopril Flomax Singular Zyrtec

Current Illness: none

ID: 1299873
Sex: M
Age: 72
State: IN

Vax Date: 03/03/2021
Onset Date: 04/13/2021
Rec V Date: 05/08/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Right leg burning, red, swollen. Doppler showed XL blood clot and numerous small clots in right leg. Put in Eliquis for2-3 wk. brought to hospital on 5.6.21 with worse swelling, red, and right foot very painful. CT showed clots in legs and in lungs. Still in hospital as of 5.8.21

Other Meds: Jardiance Novolog Lantus Atenolol Paxil Pantoprazole Furosemide Buspirone Gabapentin Olmesartin

Current Illness: Diabetic Heart disease

ID: 1299874
Sex: F
Age: 52
State: MT

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Bactrim, Flagel, Augmentin, amoxicillin. soy, rye, barley, rye, rice, tomatoes , strawberries, chocolate, fish, shellfish.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: throat swelled, sweating, couldn't breath, light headed, fast heart rate. was given Benadryl and monitored closely for 30 min. (until I felt better)

Other Meds: estradiol, medroxyprogesterone, vitamin d3

Current Illness: none

ID: 1299875
Sex: F
Age: 26
State: PA

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Shell fish, mushroom Seasonal allergy

Symptom List: Diarrhoea, Nasal congestion

Symptoms: My daughter had 4 mild seizures after she received the 2nd dose of the Pfizer. Her first seizure was 25 minutes after and other seizures were 25-30 minutes apart until I gave her Clonazepam for her on going seizures.

Other Meds: Synthroid, Trileptal & Levetiracetam ( seizure medicines), Iron, Sodium Chloride, D3 vitamin, Elderberry, Multi- Vitamin

Current Illness: None

ID: 1299876
Sex: F
Age: 49
State: NV

Vax Date: 01/14/2021
Onset Date: 01/15/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Neomycin, cilantro, pineapple, mango, papaya

Symptom List: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: After my vaccine, one day after my right arm and leg broke out little red bumps, were itchy and blistery, looked like hives. I went to clinic where I was prescribed Prednisone, Bactrim and a topical cream. My symptoms lasted two weeks then they started to go away.

Other Meds: None reported

Current Illness: None reported

ID: 1299877
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: redness and swelling at injection site

Other Meds:

Current Illness:

ID: 1299878
Sex: F
Age: 56
State: CA

Vax Date: 03/16/2021
Onset Date: 03/17/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Bactrim, prednisone ; Migraine allergies to bananas, pineapple; Fibro allergies to caffeine, sugar

Symptom List: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Shot #1 (036A21A) 03-16-21 Shot at 4:00 p.m. ? bad migraine that night 03-17-21 Bad migraine 03-18-21 Shingles outbreak Ongoing for3 weeks 04-17-21 IBS, Extreme Fatigue (overlapping w/ Shot #2) Shot #2 (042B21A) 04-14-21 Shot at 4:00 p.m. 04-15-21 -- I felt OK during the day, had the sniffles 9:30 p.m. ? I had a moderate head cold with sneezing and sniffles ? took Nyquil 04-16-21 Severe head cold, chest congestion, asthma flare, some trouble breathing ? took DayQuil and Sudafed all day Migraine Ongoing and still today?.. 05-08-21 I still have chest congestion, trouble breathing, sinus congestion, cough ? taking DayQuil and Sudafed all day every day Still having more migraines than usual ? using more Imitrex Tablets and Spray than usual; More fatigue than usual; using Asthma inhalers more than usual

Other Meds: Daily Rx Levothyroxine Rx 100 mcg /day Monthly Rx Magnesium Sulfate Infusion Rx 2 gr. IV drip (Migraines) Daily OTC: Baby Aspirin (81 mg.) (Rx) Metagenics Vit. D3 5,000 iu Metagenics EPA-DHA 720 fish oil 1,000 iu Metag

Current Illness: Various shingles outbreaks

ID: 1299879
Sex: M
Age: 30
State: CA

Vax Date: 05/06/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Penecillin, doxycycline hyclate, sulfa drugs

Symptom List: Dyspnoea, Fatigue, Feeling abnormal, Head discomfort, Headache

Symptoms: Recurring fever, chills, cold sweats, body pain / soreness, massive headache, constant discomfort, lethargy

Other Meds: Pantoprazole

Current Illness: Shortness of breath possibly due to acid reflux

ID: 1299880
Sex: F
Age: 52
State: CO

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NKA

Symptom List: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: CLIENT BECAME DIZZY, DIAPHORETC-POST VACCINE 5 MINUTES. ESCORTED TO EXAM ROOM-PRONE WITH LEGS ELEVATED. CONTINUES TO C/O DIZZINESS, FLUSHING AND WEAKNESS. UNABLE TO SIT UPRIGHT WITHOUT INCREASE IN SYMPTOMS. C/O WEAKNESS. RAPID RESPIRATIONS BUT DENIES DIFFICULTY BREATHING. EMS CONTACTED. TRANSPORTED TO HOSPITAL.

Other Meds: NONE

Current Illness: NONE

ID: 1299881
Sex: M
Age: 26
State: MI

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: NO

Symptom List: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Light headed , he passed out and fall on the floor

Other Meds: No

Current Illness: No

ID: 1299882
Sex: M
Age: 42
State: PA

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: none

Symptom List: SARS-CoV-2 antibody test, SARS-CoV-2 test negative

Symptoms: syncopal event in observation area, refused hospital transport

Other Meds: mescalamine

Current Illness: collitis

ID: 1299883
Sex: M
Age: 58
State: MN

Vax Date: 03/19/2021
Onset Date: 03/20/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: Ragweed

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Extreme Fatigue, Inability to Focus, Concentrate , Brain Fog

Other Meds: Paxil Lisinopril Flomax Singular Zyrtec

Current Illness: none

ID: 1299884
Sex: F
Age: 35
State: MN

Vax Date: 04/28/2021
Onset Date: 05/02/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: about a week after getting my second dose, i broke out in hives, across my abdomen and both thighs, along with my back. they were red swollen and extremely itchy. several of them also joined together to make one huge hive. at first i thought i'd been bitten by something and go freaked about that many bites all at once, but after looking at pictures of bug bites (ugh) i concluded that they were hives and behaved the way mosquito bites do on me. they went away after a shower on the 2nd but reappeared on the 3rd early in the morning, even more widespread and itchy. i took an antihistamine and they went away. i took another dose later in the day when it seemed like it might be starting again. they've been gone since then even without taking more antihisamines.

Other Meds: lamotrogine, metformin, duloxitine, trazadone, bupropion

Current Illness:

ID: 1299885
Sex: F
Age: 31
State: SC

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data:

Allergies: Aleve

Symptom List: Blood pressure increased, Chest discomfort, Heart rate increased

Symptoms: Pt states she developed a rash a few hours after vaccine. Rash on face, neck, chest and back.

Other Meds: None

Current Illness: None

ID: 1299886
Sex: M
Age: 16
State: MI

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: nuts, eggplant, sesame seeds, honeydew, coconut

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Lymph node pain, Lymphadenopathy

Symptoms: Patient being observed post covid vaccination for hx of anaphylaxis with nuts and many foods. At 30 minute mark, he was observed to have faint hives at left side of face and under chin. Trunk clear. No s/sx of distress. Evaluated by EMS - mouth, throat, lungs clear to auscultation . Patient and his mom decline Benadryl IM - discharged to home. Intends to take PO Benadryl.

Other Meds: albuterol, benadryl, epi pen

Current Illness:

ID: 1299887
Sex: F
Age: 27
State: TN

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Latex and penicillin

Symptom List: Unevaluable event

Symptoms: Hot flashes, swelling of mouth and throat, fatigue, bloody nose, shaky, nausea, loss of appetite and taste, achy and pain and nerve aching, migraines

Other Meds:

Current Illness:

ID: 1299888
Sex: M
Age: 62
State: CA

Vax Date: 03/27/2021
Onset Date: 03/29/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Severe cough. Doctors ruled it likely a side effect of the Jansen vaccine, and also decided that combined with Meloxicam, a medication that promotes bleeding, led to a torn flank and internal bleeding. Hospitalized for 2 days. Rehab ongoing.

Other Meds: Acyclovir, alvesco, atorvastatin, benzotropine, carbidopa-levodopa, Citalopram, Clonazepam, entacopone, fluticasone, lamivudine, Meloxicam, nevirapine, nortriptyline, Omeprazole, propranolol, quetiapine, testosterone, topiramate, Ventolin,

Current Illness:

ID: 1299889
Sex: F
Age: 47
State: MI

Vax Date: 05/06/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain, Pain

Symptoms: Large swollen lymph nodes under left arm Very painful and visible

Other Meds: Wellbutrin Xyzal Multivitamin Vitamins C, D3 Ginko Biloba Probiotic Biotin

Current Illness: None

ID: 1299890
Sex: M
Age: 64
State: MA

Vax Date: 05/01/2021
Onset Date: 05/02/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: No

Symptom List: Injection site pain, Menorrhagia

Symptoms: -Tinnitus occurred within 24 hours of receiving second Moderna Dosage. - Still occurring after 6 days, with no relief. Actual increasing after the 4th day.

Other Meds: Vitamin D-1.25 mg, once a week

Current Illness: No

ID: 1299891
Sex: F
Age: 78
State: TX

Vax Date: 02/23/2021
Onset Date: 04/20/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: amoxicillin, nitrofurantoin macrocrystalline, and sulfa (sulfo

Symptom List: Arthralgia, Chills, Headache, Mobility decreased, Myalgia

Symptoms: This full body rash itches and burns. PHOTOS OF SIMILAR APPEARING RASHES, AS CAUSED BY COVID19 VACCINES, MAY BE FOUND ON:

Other Meds: MEMANTINE HCL TAB 5MG twice daily; Vitamin D3 400mg once day

Current Illness: MCI, hyperlipidemIa

ID: 1299892
Sex: F
Age: 35
State: NJ

Vax Date: 04/29/2021
Onset Date: 05/06/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Ceclor

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Initial event (the evening after) stomach pains/cramps, next day slight dizziness like a cold was coming on. Redness and swelling at the injection sight remained and began to get larger, redder, and more uncomfortable seven days after. Area continuing to grow in size on day 9 (today)

Other Meds: Claritin

Current Illness:

ID: 1299893
Sex: F
Age: 43
State: NY

Vax Date: 04/28/2021
Onset Date: 04/29/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 24 Hours after injection, I had a high fever and headache for the next 24 hours. Over the next week, extreme itching all over my body. A week later, my rosacea flared. The autoimmune response set off an inflammation of my face in the locations where my rosacea is commonly triggered. I recovered from the fever but the skin itching and face swelling has not calmed down - I need to take doxycycline and Alleve to lower the rosacea swelling and redness.

Other Meds:

Current Illness: Rosacea

ID: 1299894
Sex: F
Age: 59
State: NJ

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Patient's first dosage of covid vaccine was on 04/17/2021. Patient was given second dosage on 05/07/2021. This is only 20 days separation from 1st dose, Manufacturer recommendation is 21 days from 21st dose

Other Meds:

Current Illness:

ID: 1299895
Sex: F
Age: 45
State: OH

Vax Date: 02/26/2021
Onset Date: 02/27/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Patient has had pain in the left arm/deltoid since injection. Pain prevents her from lifting.

Other Meds:

Current Illness:

ID: 1299896
Sex: U
Age: 26
State: IL

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: N/A

Symptom List: Injection site pain

Symptoms: A 26 yo male experienced a syncopal episode for approx. 12 seconds X2 at 10 min after receiving J&J vaccine (L) deltoid. No post-itch symptoms and no loss of bowel or bladder. He became nauseous with emesis X1. Declined transport to hospital. His uncle provided transport home.

Other Meds: METFORMIN

Current Illness: N/A

ID: 1299897
Sex: F
Age: 24
State: WA

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Mucinex (gives me vertigo)

Symptom List: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Vertigo/Dizziness starting the same day of vaccination. More noticeable over time and persisting almost 4 days post vaccination. Settles when at rest. Becomes increasingly noticeable and to the point of debilitating when moving/bending/driving.

Other Meds:

Current Illness:

ID: 1299898
Sex: M
Age: 37
State: CA

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Dizziness, Nausea, Pain, Tachycardia

Symptoms: Patient came into the vaccine clinic for their 2nd dose booster. They were mistakenly given Moderna Vaccine instead of the Pfizer vaccine. No adverse reactions occurred. The patient was alert, oriented, ambulatory, stable, and left the clinic in stable condition.

Other Meds:

Current Illness:

ID: 1299899
Sex: M
Age: 37
State: MN

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Not that I know of

Symptom List: Tremor

Symptoms: Headache, facial pain mostly on the left side, and ear ringing (left ear)

Other Meds: Sertraline

Current Illness: None

ID: 1299900
Sex: F
Age: 33
State: WI

Vax Date: 04/28/2021
Onset Date: 05/08/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: shaking reaction to an unknown injected numbing agent at a dentist office, environmental allergies to mold/dust/pollen

Symptom List: Erythema, Pruritus

Symptoms: Itchy, swollen, partially red, and raised area around injection site, noticed 10 days after injection. No pus, drainage, or broken skin. Red area approx 1.5" diameter. Symptoms mild as of completion of this form, I am submitting the form because I had only heard of this delayed reaction spoken of for the Moderna vaccine, whereas I had the Pfizer vaccine. I had had some arm soreness onset about 6 hours or so after I received the vaccine, but I had not noticed this continuing red spot until today.

Other Meds: Bystolic 2.5 mg, quinapril/hydrochlorothiazide 10/12.5 mg, omeprazole 30 mg, all doses 1x/day

Current Illness: none known

ID: 1299901
Sex: F
Age: 44
State: OR

Vax Date: 04/24/2021
Onset Date: 05/01/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies: none

Symptom List: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling, Myalgia

Symptoms: Was alarmed by sensations that I would lose consciousness as I was lying on the couch watching a movie with my kids. Used a pulse oximeter and heart rate was dipping into 50's during the sensation. Intestinal spasms started and was followed by diarrhea. I decided to go to sleep. The next morning woke fine, then was seated doing some computer work and the sensation started again, accompanied by sharp, stabbing chest pain, again intestinal spasms and diarrhea. Pulse rate was again dipping. I went to urgent care, had an EKG, they felt it was slow so sent me to the ED. Had another EKG and some monitoring. Chest pain continued, and sensation that I would lose consciousness continued into the following day. The only diagnoses was Vasovagal presyncope.

Other Meds: none

Current Illness: none

ID: 1299902
Sex: F
Age: 47
State: WI

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: tarantulas, Aleve, amoxicillin, Lyrica, naproxen, Vigamox, sulfa antibiotics, tramadol

Symptom List: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: The patient complained of tongue swelling, hoarse voice and a dry throat. She did not have difficulty breathing and refused EpiPen administration. The patient contacted the pharmacy on 5/8/21 to report a rash.

Other Meds: alendronate, bupropion, celecoxib, cetirizine, clonazepam, cyclobenzaprine, escitalopram, estradiol, Flovent, Sudafed, Vitamin D, methylphenidate, mometasone nasal spray, morphine, oxcarbazepine, pantoprazole, rizatriptan, valacyclovir, Vas

Current Illness:

ID: 1299903
Sex: U
Age: 21
State: MA

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt was vaccinated at the drive through clinic on 4/23. When he was asked at our clinic if he received a vaccination within the last 14 days he said "No". Pt was given the vaccine and then resented his vaccination card. The vaccinator realized the 1st dose was only 14 days ago. We referred pt to his PCP

Other Meds:

Current Illness:

ID: 1299904
Sex: F
Age: 0
State: AZ

Vax Date: 03/23/1947
Onset Date: 03/30/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Sulfa drugs

Symptom List: Injection site erythema, Injection site pain, Injection site swelling

Symptoms: The day after the vaccination i had aches and chills, lasted about 24 hours and then went away completely. About a week after the vaccination i started to get pains in my joints and bones, especially the left elbow. I also had a swollen underarm gland in the left armpit. Now over a month later the swelling has gone away but I still feel achy at times. Recently, I have been experiencing a fatigue and real tiredness that prevents me from being as active as I had been. Not sure it is from the vaccine or my diuretic or my blood pressure medication, but I have been on those about one year with no problem. I am wondering if it is the vaccine. I never had joint pains prior to the vaccine.

Other Meds: .025 xanax at night only, Losartan Potassium 25mg daily, Hydrochlorothiazide 12.5 daily, Vit C, D, B.

Current Illness: None except chronic low back pain from severe stenosis and feet issues due to sensory peripheral neuropathy.

ID: 1299905
Sex: F
Age: 34
State: PA

Vax Date: 04/30/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Penicillin, amoxicillin, zithromax

Symptom List: Chills, Feeling cold, Feeling hot, Myalgia, Pain

Symptoms: A week after the injection I have a small red bump, about a half inch in diameter, at injection site. My arm is itchy around the bump, but the bump itself is painful to the touch. My upper arm in general is still a little sore, although much better than the day after my shot. Additional reactions: The evening of my shot and the day after I had typical symptoms. My entire arm, from shoulder to wrist, was very sore. This started within 30 minutes of injection. I had nausea starting about 2-3 hours after injection. That lasted the majority of the following day, on and off. I was able to eat and drink. The second day after injection I felt mostly back to normal aside from my arm being sore. My arm gradually felt better through out the week. However, the whole week I was extremely tired.

Other Meds: Metro cream 2x/day, biotin 10k mg

Current Illness: None

ID: 1299906
Sex: F
Age: 48
State: NJ

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Patient was given second dose of Pfizer covid vaccine 20 days after first dose instead of the manufacturer recommended 21 day separation.

Other Meds:

Current Illness:

ID: 1299907
Sex: F
Age: 32
State:

Vax Date: 04/23/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Abnormal behaviour, Adverse reaction, Anger, Asthma

Symptoms: cerebral venous sinus thrombosis causing tonic-clonic seizures

Other Meds:

Current Illness:

ID: 1299908
Sex: M
Age: 44
State: FL

Vax Date: 05/05/2021
Onset Date: 05/06/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Burning sensation and swollen red raised skin at eyelids, and under eyes. Grey half moon circles under eyes. Sore to touch

Other Meds: None

Current Illness: None

ID: 1299909
Sex: F
Age: 17
State: TX

Vax Date: 03/14/2021
Onset Date: 03/14/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: There was no adverse reaction but the patient was under the age of 18. She was vaccinated at an offsite clinic. She was turned away at least once but slipped back in and was vaccinated by someone who checked the year but not the month and date before vaccinating her. Her father was present and was vaccinated as well and was part of the push to get her sent back through.

Other Meds:

Current Illness:

ID: 1299911
Sex: F
Age: 59
State: WA

Vax Date: 03/31/2021
Onset Date: 04/26/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Vomiting

Symptoms: 26 days after 1st Moderna vaccine patient developed shortness of breath. Patient ended up having a positive d-dimer. CT scan done the following week showed severe bilateral pulmonary emboli in all lobes of both lungs.

Other Meds: Alprazolam Atenolol Atorvastatin Hydroxyzine Buspirone Lexapro

Current Illness: None

ID: 1299912
Sex: F
Age: 41
State: FL

Vax Date: 05/04/2021
Onset Date: 05/06/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Sulfa Codeine

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Hives - lower arms/trunk/legs (since Thursday evening)

Other Meds: Daily vitamins, cranberry, nadolol 20 mg, fiber pills

Current Illness: Seasonal allergies (live in)

ID: 1299913
Sex: F
Age: 68
State: AL

Vax Date: 02/17/2021
Onset Date: 02/20/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: codeine, morphine, tetracycline, bactrim, flagyl

Symptom List: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: lymph nodes began swelling on left side of neck. Other lymph nodes in neck swelled later. Began having trouble swallowing. Lymph nodes eventually went down but still have trouble swallowing

Other Meds: pravastatin, estradiol 10 mg, allegra

Current Illness: uti--taking keflex

ID: 1299914
Sex: F
Age: 41
State: IN

Vax Date: 05/06/2021
Onset Date: 05/06/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 5 hours after second shot I started getting body aches and pain everywhere and the pain increased over the next several hours. I took ibuprofen every 4 hours. It had subsided tremendously by 5 pm the next day. I was significantly better 12 hours after the second shot.

Other Meds: Vyvanse 40mg

Current Illness: None

ID: 1299915
Sex: F
Age: 68
State: NJ

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Patient was inadvertently given second dose of Pfizer covid vaccine 20 days after first dose instead of manufacturer recommended 21 days separation

Other Meds:

Current Illness:

ID: 1299916
Sex: F
Age: 62
State: MD

Vax Date: 05/07/2021
Onset Date: 05/07/2021
Rec V Date: 05/08/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Hot flush, Myalgia, Nausea, Tension headache

Symptoms: 15 min post vaccination c/o generalized itching. 25 Benadryl given. Pt declined to stay for further eval or treatment.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm